MEDICARE: JOSEPH W GALLAGHER OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0810	NH

General Provider Information

NPI Number	:	1558339382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH W GALLAGHER OD

Provider Business Mailing Address
First Line	:	53 S MAIN ST
Second Line	:
City	:	HANOVER
State	:	NH
Zip	:	03755-2022
Country	:	US
Telephone Number	:	603-643-2140
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 SOUTH ST
Second Line	:
City	:	HANOVER
State	:	NH
Zip	:	03755-2148
Country	:	US
Telephone Number	:	603-643-2140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	03/14/2017

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